输尿管镜下钬激光碎石术中并发输尿管穿孔原因及对策  

Causes and treatment of ureteral perforation occurred in ureteroscopic Ho:YAG laser lithotripsy

作　　者：赵永斌[1] 胡卫列[1] 吕军[1] 邓志雄[1] 曹启友[1] 邱晓拂[1] 张利朝[1] 杨菁华[1] 肖远松[1] 

机构地区：[1]全军下尿路疾病诊治中心广州军区广州总医院泌尿外科,广东广州510010

出　　处：《中国内镜杂志》2008年第2期125-127,共3页China Journal of Endoscopy

摘　　要：目的探讨钬激光治疗输尿管结石并发输尿管穿孔的原因,提高对钬激光碎石术近期输尿管穿孔的防治水平。方法对该院2004年8月～2006年12月经尿道输尿管镜钬激光碎石术的268例中的25例并发输尿管穿孔患者的临床资料进行回顾性分析。男14例,女11例;结石单发者21例,多发者4例;上段结石18例,下段结石7例;结石直径1.2～3.2cm,平均(1.8±0.5)cm,均合并输尿管息肉及肾盂积水。术后常规放置双J管4～8周。结果25例输尿管镜手术时间15～70min,平均(40.4±18.3)min。11例一次性碎石成功,6例术中即时改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石(ESWL)治疗。结论输尿管结石合并息肉是钬激光碎石致输尿管穿孔的主要原因之一,轻柔而熟练的操作是预防和治疗输尿管穿孔的关键,早期及时开放手术可以避免其他更为严重并发症的发生。[Objective] To investigate the causes of ureteral perforation occurred in ureteroscopic Ho：YAG laser lithotripsy and improve the prevention and treatment level of this complication. [Methods] Clinical data of 25 patients with ureteral perforation from 268 patients, who had received transurethral ureteroscopic lithotripsy using Ho：YAG laser lithotriptor were analyzed retrospectively. There were 14 males and 11 females. 21 cases had single stone, and 4 had more than one. 18 cases had stones in the upper ureter and 7 in the lower ureter. The size of stones were （1.2-3.2） cm in diameter with a mean of （1.8±0.5） cm. All the cases were complicated with ployp and nephrohydrosis. Double-J stents were placed after operation. [Results] The operation time was （15-70） min with a mean of （40.4±18.3） min. 11 cases had successful lithotripsy at one time, and 6 cases changed to have ureterolithotomy in operation. 8 cases received ESWL treatment one week later because of stones shift. [Conclusions] The ureteral ployp combinded with stones is the main cause of ureteral perforation occurred in ureteroscopic Ho：YAG laser lithotripsy. Light and proficient practise is the key point to prevent and treat the perforation. Early open operation could turn away the occurrence of other severe complications.

关 键 词：输尿管结石 碎石术 钬激光 穿孔 

分 类 号：R693.4[医药卫生—泌尿科学]